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Left atrial appendage thrombus secondary to left atrial ischaemia owing to impaired left atrial branch perfusion

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PROVIDER: S-EPMC9536287 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Thrombus formation on the stump of a resected left atrial appendage in a case with a history of left atrial appendage thrombus owing to left atrial ischaemia: a follow-up case report.

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Percutaneous isolation of left atrial appendage thrombus.

Project description:Most physicians regard left atrial appendage (LAA) thrombus as a contraindication for LAA occlusion due to risk of distal embolization which is a serious complication. Here we report a case of successfully implanted Amplazter cardiac plug without complication in elderly patients having LAA thrombus with recurrent embolic events despite oral anticoagulants for prevention of thromboembolic events. <Learning objective: LAA thrombus is not completely resolved in all cases and can be a potential source of stroke or embolization even during anti-coagulation. We would like to share a case that suffered from 6 strokes or embolizations despite anti-coagulation, warfarin or non-vitamin K antagonist oral anti-coagulants due to incomplete resolution of LAA thrombus. In this clinical situation, we can suggest LAA occlusion to isolate thrombus from LA and prevent further stroke or embolization.>.

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Epicardial fat mimicking left atrial appendage thrombus.

Project description: Not available

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Overcoming barriers for left atrial appendage thrombus: a systematic review of left atrial appendage closure.

Project description:BackgroundApproximately 90% of intracardial thrombi originate from the left atrial appendage in non-valvular atrial fibrillation patients. Even with anticoagulant therapy, left atrial appendage thrombus (LAAT) still occurs in 8% of patients. While left atrial appendage closure (LAAC) could be a promising alternative, the current consensus considers LAAT a contraindication to LAAC. However, the feasibility and safety of LAAC in patients with LAAT have yet to be determined.MethodsThis systematic review synthesizes published data to explore the feasibility and safety of LAAC for patients with LAAT.ResultsThis study included a total of 136 patients with LAATs who underwent successful LAAC. The Amulet Amplatzer device was the most frequently utilized device (48.5%). Among these patients, 77 (56.6%) had absolute contraindications to anticoagulation therapy. Cerebral protection devices were utilized by 47 patients (34.6%). Transesophageal echocardiography (TEE) is the primary imaging technique used during the procedure. Warfarin and novel oral anticoagulants were the main anticoagulant medications used prior to the procedure, while dual antiplatelet therapy was primarily used post-procedure. During a mean follow-up period of 13.2 ± 11.5 months, there was 1 case of fatality, 1 case of stroke, 3 major bleeding events, 3 instances of device-related thrombus, and 8 cases of peri-device leakage.ConclusionsThis review highlights the preliminary effectiveness and safety of the LAAC procedure in patients with persistent LAAT. Future large-scale RCTs with varied LAAT characteristics and LAAC device types are essential for evidence-based decision-making in clinical practice.

| S-EPMC10956221 | biostudies-literature

Percutaneous left atrial appendage closure using the LAmbre device in patients with atrial fibrillation and left atrial appendage thrombus.

Project description:BackgroundLeft atrial appendage closure (LAAC) is considered a valid alternative for the prevention of thromboembolic stroke in patients with persistent left atrial appendage thrombus (LAAT) despite adequate anticoagulation. However, the data on LAAC using the LAmbre device for patients with LAAT is limited. This study was performed to explore efficacy and safety as well as to share the experience of the modified LAAC procedure with the LAmbre device.Materials and methodsA total of 7 patients with persistent LAAT despite adequate anticoagulation underwent modified LAAC with the LAmbre device between November 2019 and April 2022. Transesophageal echocardiography was performed 3 months postoperatively to detect device-related thrombosis and peridevice leak. The patients' clinical events were evaluated during the perioperative and follow-up periods.ResultsThe median age, CHA2DS2-VASc score, and HAS-BLED score of all patients were 71 [53-73], 3 [2-4], and 2 [2-3], respectively. In the procedure, a cerebral protection system was used in two patients. LAAC with the LAmbre device was successfully performed in all patients without perioperative events. During the median follow-up of 383 [325-865] days, postoperative transesophageal echocardiography was performed in six (85.7%) patients. Device-related thrombosis was detected in one (16.7%) patient, and no significant peridevice leak was observed. No thromboembolic event or bleeding event occurred in any patients.ConclusionLAAC with the LAmbre device is effective and safe when performed by experienced operators in highly selected patients with LAAT after adequate anticoagulation.

| S-EPMC9729287 | biostudies-literature

Supramitral membrane with left atrial appendage thrombus: A rare entity.

Project description:A 4-year-old child with supramitral membrane (SMM) causing severe mitral stenosis (MS) was taken for excision of the membrane. Intraoperative transesophageal echocardiography showed a large thrombus in the left atrial appendage (LAA) in addition to SMM. The case underscores the importance of this extremely rare association and prompt therapy to prevent catastrophic consequences.

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How to safely occlude left atrial appendage with a thrombus inside?

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A great mimic of left atrial appendage thrombus in a patient with atrial fibrillation.

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| S-EPMC8453384 | biostudies-literature

Left atrial appendage thrombus on full-dose dabigatran treatment: a case report.

Project description:Background:Dabigatran is a direct competitive thrombin inhibitor approved for stroke prevention in non-valvular atrial fibrillation. At full-dose, dabigatran showed similar rates of bleedings and higher efficacy compared to warfarin. Case summary:We report a case of acute ischaemic stroke in a patient treated with dabigatran 150?mg b.i.d. for atrial fibrillation. After an off-label treatment with idarucizumab, a humanized monoclonal antibody approved for dabigatran reversal, we performed a successful intravenous thrombolysis (IVT). Transoesophageal echocardiography showed a left atrial appendage (LAA) thrombus, despite full-dose dabigatran and an adequate therapy adherence. Discussion:There are few cases of LAA thrombus during dabigatran treatment reported in literature till date. We analyse the possible pathogenetic mechanisms involved in dabigatran failure, including drug interactions and unexpected genetic variations interfering with dabigatran serum levels suggesting periodical assessment of direct Oral Anticoagulant levels. Furthermore, we confirm initial reports of safety and efficacy of intravenous thrombolysis after idarucizumab, in case of dabigatran failure.

| S-EPMC7319812 | biostudies-literature

Left atrial appendage thrombus detected by transesophageal examination with linear endoscopic ultrasound.

Project description:Linear endoscopic ultrasound (L-EUS) is mainly performed to assess pancreaticobiliary and mediastinal diseases. In this report, transesophageal observation with L-EUS revealed an LAA thrombus that was not detected by transthoracic echocardiography. This report highlights a novel potential role for L-EUS in the detection of cardiovascular diseases including LAA thrombi.

| S-EPMC6637345 | biostudies-literature

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